title: Correlation between time to diagnosis and rehabilitation outcomes in patients with spinal dural arteriovenous fistula.
abstract: BACKGROUND
  Spinal dural arteriovenous fistulas (SDAVFs) are the most common spinal vascular malformations and can be a significant cause of myelopathy although they are under diagnosed. Surgical or embolization treatment of SDAVFs improved significantly in the last decade. However, a high percentage of patients are still left with severe disability.
  
  
  OBJECTIVE
  To describe the correlation between time to diagnosis and the rehabilitation outcomes of eight patients with SDAVFs.
  
  
  METHODS
  Retrospective chart study of all SDAVF patients in 20 years.
  
  
  METHODS
  A tertiary university rehabilitation center.
  
  
  METHODS
  The lower extremities motor score (LEMS), Functional Independence Measure (FIM), Spinal Cord Independence Measure (SCIM) and Walking Scale for Spinal Cord Injury (WISC II). Overall prognosis was evaluated using the Aminoff-Logue scale (ALS).
  
  
  RESULTS
  There were seven men and one woman with mean age of 61.3 ± 15 (30-72) and mean time until the diagnosis of SDAVF of 265.5 ± 245 days (4-730). At the end of rehabilitation period, five of the eight patients remained wheelchair dependent. Strong correlation was found between LEMS, FIM, SCIM, and WISC II scores and the functional level according to the ALS scale. A significant correlation was found between time to diagnosis and the height of the SDAVF, the clinical and rehabilitation outcomes. Patients with high SDAVF which were diagnosed late had the poorest prognosis.
  
  
  CONCLUSIONS
  The potential for functional ambulation in patients with SDAVF is related to the time of intervention. This finding emphasizes the important of early diagnosis and early intervention in SDAVF.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Yona
authors.initials: Y
authors.lastname: Ofran
authors.forename: Ivelin
authors.initials: I
authors.lastname: Yovchev
authors.forename: Nurith
authors.initials: N
authors.lastname: Hiller
authors.forename: Jose
authors.initials: J
authors.lastname: Cohen
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Rubin
authors.forename: Isabella
authors.initials: I
authors.lastname: Schwartz
authors.forename: Zeev
authors.initials: Z
authors.lastname: Meiner
mesh_terms: D000328:Adult; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000175:diagnosis* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function; D013118:Spinal Cord Diseases / Q000150:complications / Q000175:diagnosis* / Q000534:rehabilitation*; D013995:Time; D016896:Treatment Outcome